1
Standardizing Opioid and Drug Abuse Referrals to Rehabilitation
Session ID: BP4, February 11, 2019
Kristin Hill, MA, Practice Administrator, Population Behavioral Health,
Dept. of Psychiatry, Rush University Medical Center, Chicago, IL
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Kristin Hill, MA has no real or apparent conflicts of interest to report.
Conflict of Interest
3
Kristin Hill, MA
Salary: Rush University Medical Center
Royalty: None
Receipt of Intellectual Property Rights/Patent Holder: None
Consulting Fees (e.g., advisory boards): None
Fees for Non-CME Services Received Directly from a Commercial Interest or their
Agents (e.g., speakers’ bureau): None
Contracted Research: None
Ownership Interest (stocks, stock options or other ownership interest excluding
diversified mutual funds): None
Other: These services are supported in-part by a contract to Rush University Medical
Center from the Illinois Department of Human Services, Division of Substance Use
Prevention and Recovery, as part of the Illinois Opioid-State Targeted Response grant
from the U.S. Department of Health and Human Services, Substance Abuse and Mental
Health Services Administration (TI-080231).
Grant No.: 43.788
Agreement No.: 43CXZ03198
Conflict of Interest
4
• Background on Opioids / Epidemic in Chicago
• Rush’s Response: Screening, Brief Intervention and Referral to
Treatment (SBIRT) and Substance Use Intervention Team (SUIT)
– Description
– Design Principles
– Integration with Electronic Medical Record
• Intended Outcomes
• Actual Outcomes
– Identification of Unique Population
– Length of Stay
– SUIT Growth
Agenda
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• Illustrate how to adapt currently available risk assessment
tools into an EHR-enabled nursing workflow
• Describe how to facilitate electronic handoffs to social
workers to provide secondary assessments for patients
identified as potential risks for opioid abuse
• Outline how to create a Substance Use Intervention Team
(SUIT) team to drive at-risk patients to available
rehabilitation and support services to help them combat
their addiction
Learning Objectives
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Background on Opioids
Opiates are a class of
painkillers that include
morphine and heroin
National rate of drug
overdose deaths has
increased over last 15 yrs
Opioid deaths have
drastically increased in
the last 3 years, despite
federal mandate to
decrease opioid prescribing
https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
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Opioid Epidemic in Chicago
Total # of overdose
deaths involving
opioids in 2017
*
Opioid overdose
deaths per 100K
Chicago: 17.2
*
National: 14.7
**
Percentage of
overdose deaths
involving heroin
and fentanyl
*
17%
higher
90%
796
0
<10
10-20
20-33
33-51
51-93
Opioid
Overdose
Death Rate
(per 100K)
*
https://www.chicago.gov/content/dam/city/depts/cdph/CDPH/Healthy%20Chicago/ChicagoOpioidReport2018.pdf
**
https://www.cdc.gov/drugoverdose/data/statedeaths.html
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Rush’s Plan to Address Epidemic
Screen all
inpatient
admissions
for substance
use disorders
using SBIRT
Launch
SUIT
inpatient
consult
service
Launch
SUIT
outpatient
clinic
for acute
follow-up
Launch
addiction
medicine
fellowship
program
Provide
treatment
services
to 1,200
patients per
year
SBIRT = Screening, Brief Intervention
and Referral to Treatment
SUIT = Substance Use
Intervention Team
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SUIT Program Components
EMR
Analytics
Inpatient
Analyst
Ambulatory
Analyst
SBIRT/MI
Intervention
Inpatient
Social
Workers
Universal
Screening
Inpatient
Nurses
Inpatient
SUIT Consult
Service
Attending
Physician
Social
Worker
Adv. Practice
Practitioner
Pharmacist
Outpatient
SUIT
Clinic
Medical
Toxicologist
Licensed Clin.
Social Worker
Certified Med.
Assistant
Pharmacist
Psychiatric
Nurse Pract.
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SUIT Program Workflow
Inpatient
Social
Worker
Completes full AUDIT/
DAST questionnaire
Completes CM
flowsheet in Epic
Does brief
intervention and refers
to SUIT consult or other
treatment
Inpatient
Nurse
Gives two-question
screen during
admission
Inpatient SUIT
Consult
Service
Completes rounds on
identified patients
SUIT social worker
orchestrates appt. to
outpatient clinic and
other resources
Outpatient
SUIT
Clinic
Offers Medication-
Assisted Treatment,
psychotherapy, and
case management
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SUIT Program Reduces Barriers to Treatment
Outpatient SUIT Clinic
staffed with two
suboxone providers
Universal screener
via EMR admission
processes
Access to Care
Primary providers on
SUIT are emergency
medicine physicians
trained in medical
toxicology
Affordability Education
Naloxone distribution
and counseling for
patients and family
members
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Universal Screening Using the EMR
Ease of
Documentation
and Reporting
Multidisciplinary
Communication
Encouraged
Flexibility to
change and adopt
new screeners
Continuity
of Care
Encouraged
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Why was Universal Screening used?
Includes all patients in
screening to remove
exclusion bias
(no specific race,
socioeconomic status, or
diagnosis prevents one from
substance misuse)
Decreases
Bias
Decreases
Stigma
Normalizes questions about
substance use, making
them similar to those about
blood pressure, age, body
mass index, etc.
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Building an Interdisciplinary Team
Social Work
Nursing
Information
Technology
Emergency
Medicine /
Medical
Toxicologist
Pharmacy
Medical
Staff &
Patient
Education
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Initial Two-Question Substance Use Screen in Epic
Inpatient
Nurse
Gives two-question
screen during admission
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Utilizing Epic for Inpatient Status Reporting
Unscreened patients
Negative screen
Positive screen
CM intervention completed
Consult to SUIT needed
Screening deferred
Icons within
Unit Patient
List in Epic
Substance Use
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Alcohol and Drug Abuse Screens in Epic
Auto-Calculated Score for Alcohol
Use Disorders Identification Test
Inpatient
Social
Worker
Completes full AUDIT/ DAST
questionnaire
Completes CM flowsheet
in Epic
Does brief
intervention and refers to SUIT
consult or other treatment
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Perpetual Improvement of Screenings
Updated
Intervention
Screening in Epic
Go-Live August
2018
Efficient use
of technology
to improve
screeners
Clear and
consistent
communication
b/w IS and
SUIT
Timely and
effective
improvement in
patient care
outcomes
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Intended Outcomes of SUIT Program
To improve upon early
intervention to provide
the best medical care
To provide
comprehensive
treatment for patients
according to their need
Identification
Early
Intervention
Treatment
Length of
Stay
To decrease the
length of stay and
readmissions for this
population
To identify a population
of patients in need of
treatment for
substance misuse
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Actual Outcomes: Inpatient Screening Data (11/2017-10/2018)
Inpatient
Population
34,893
Universal
Screen
31,274
(89%)
Secondary
Screen
1,428
(5%)
Brief
Intervention
1,390
(97%)
SUIT
Consults
790
(57%)
Inpatient
MATs
99
(13%)
Patients from
medical and
surgical
inpatient
units
Q1: Alcohol
misuse in
past year?
Q2: Drug
misuse in
past year?
Patients who
received
AUDIT/DAST
questionnaire
Patients who
received
motivational
interviewing
Patients
referred to SUIT
for evaluation,
treatment
planning, and
linkages to care
Patients
started on
buprenorphine
during
inpatient stay
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Anecdotal Outcome
- A patient whom was
referred by another
former user to get proper
help
“If you go to Rush,
they will help you.”
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Actual Outcomes: Identification of a Unique Population
752
# of Consult
Orders to
Psychiatry
# of Consult
Orders to
SUIT
692 790
Pre-SUIT
Nov 2016 –
Oct 2017
Post-SUIT
Nov 2017 –
Oct 2018
o New consults to SUIT did not significantly
decrease number of consults to Psychiatry
o SUIT consults represent unique population
4.2 1.9
Time to
Consult
(days)
Nov 2017 –
Oct 2018
Consults to
Psychiatry
Consults to
SUIT
o Shorter time to consult leads to improved
care and decreased LOS
Post-SUIT
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Actual Outcomes: Length of Stay
(Patients with SUD secondary diagnosis)
Length of Stay
The mean length of stay was 1.02
days shorter (p = 0.07, one-tail) for
patients who received a SUIT Consult
versus those who did not.
30-Day Readmissions
The 30-day readmission rate
decreased among patients who
received a SUIT consult (6.5%) versus
those who did not (10.3%).
6.31
5.29
Number of Days
LENGTH OF STAY
w/o
SUIT
consult
w/
SUIT
consult
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Actual Outcomes: Outpatient SUIT Clinic Data
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77
101
103
117
127
154
140
150
140
12
25
35 35
51 51
52
55
58
66
0
20
40
60
80
100
120
140
160
180
Appointments Scheduled Active Patients
The outpatient
SUIT clinic has
grown significantly
from January to
October 2018.
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SUIT Intervention Value Derived
Intended
Outcomes
Improve early
intervention to
provide the best
medical care
Provide
comprehensive
treatment for pts
according to need
Identify patients in
need of treatment
for substance
misuse
Decrease the
length of stay and
readmissions for
this population
Actual
Outcomes
Leveraged
EMR to
implement
the SBIRT
methodology
and workflow
Identified a
unique
population in
need of
substance
use treatment
Implemented
screening
mechanisms
for substance
misuse
across 20
inpatient units
and ER
Collected
compelling
data from
EMR to
support grant
and program
reporting
Realized ROI
savings to
hospital for a
decrease in
LOS for
patients with
a secondary
diagnosis for
substance
use
Established
an
outpatient
SUIT clinic
to provide
MAT, psycho-
therapy and
case
management
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• Contact information:
• Kristin_Hill@rush.edu
• linkedin.com/in/kristin-hill-93311a86
• Attendees: Please complete online session evaluation!
Questions
